Annals for Educators - September 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesSeptember 2023Annals for Educators - September 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202309190 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsSocial, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S. Adults. An Observational StudyDespite a substantial reduction in cardiovascular disease mortality in the U.S. general population, racial and ethnic disparities persist. This study examines the degree to which these racial differences remain once measured behavioral factors, metabolic risks, and social determinants of health are accounted for.Use this article to:Discuss the concept of confounding and how it applies in this study.Review the concept of social determinants of health. This article and this article may help guide the discussion. Discuss the implications of the various ways clinical studies define race.Ask your learners to list pros and cons of including race as a variable in clinical studies.Given the findings of this study, should race be included if good data on social determinants of health are available?Role of Artificial Intelligence in Colonoscopy Detection of Advanced Neoplasias. A Randomized TrialReal-Time Computer-Aided Detection of Colorectal Neoplasia During Colonoscopy. A Systematic Review and Meta-analysisFrom Tool to Team Member: A Second Set of Eyes for Polyp DetectionArtificial intelligence (AI)–assisted colonoscopy aims to augment colorectal polyp detection by human endoscopists. The primary objective of the randomized trial was to investigate whether AI-assisted colonoscopy enables endoscopists to identify more patients with advanced colorectal polyps than conventional colonoscopy. The aim of the systematic review and meta-analysis was to synthesize the findings from trials that compared computer-assisted colonoscopy versus standard colonoscopy. The accompanying editorial discusses the findings of both studies and the implications for integration of computer-assisted endoscopy into routine clinical practice.Use these articles and the editorial to:Review the definition of artificial intelligence as it applies in health care.Invite a gastroenterologist to your session to explain how computer-assisted endoscopy works from the point of view of the endoscopist.Discuss the concept of overdiagnosis and why increasing the rate of polyp detection with computer-assisted endoscopy is not necessarily beneficial.Estimating Breast Cancer Overdiagnosis After Screening Mammography Among Older Women in the United StatesUnderstanding the Varying Biological Behaviors of Breast and Other Types of Cancer to Avoid OverdiagnosisThis study used fee-for-service Medicare claims linked to the SEER (Surveillance, Epidemiology, and End Results) program registry to compare breast cancer diagnosis and death in a population of U.S. women aged 70 to 85 years in order to estimate the overdiagnosis rate. The accompanying editorial discusses the findings and why we must recognize breast cancer as not one entity but many distinct diseases with potentially different behavior patterns calling for different approaches to address overdiagnosis.Use this article and the editorial to:Review the concept of overdiagnosis. Why is it harmful?Ask your learners the age at which they think women should cease breast cancer screening.Ask your learners to identify factors that should be included when discussing whether to continue mammography in patients older than 70 years.A Zebra Among the Horses: Clinical Implications of Malaria in the United StatesThe first instance of locally acquired malaria in the United States in 20 years was recently documented. This article describes important ways in which internal medicine physicians and other clinicians can contribute to the control of malaria.Use this article to:Invite a pathologist to join your session to show slides of patients with malaria.Review the clinical presentations that should indicate malaria as a possible diagnosis.Invite an infectious disease physician to join your session to review the appropriate treatment of malaria.Factors Associated With Circulating Sex Hormones in Men. Individual Participant Data Meta-analysesTo describe patterns of testosterone concentrations among men across a range of sociodemographic, lifestyle, and health characteristics, the authors systematically searched and obtained individual participant and aggregate data from eligible cohort studies. This study reports the findings from a 2-stage random-effects meta-analysis of 9 studies with individual patient data and 2 studies with aggregate data.Use this article to: Watch the video summarizing the review with your learners. Review the methods of systematic review and meta-analysis and discuss why individual patient–level meta-analyses are more robust than those that do not use individual patient–level data.Review the normal ranges for testosterone reported by your institution's laboratory.Given the findings of this review, ask your learners how they would manage a 75-year-old man who presented with results of tests done at a different laboratory that show a low testosterone level. This ACP clinical guideline can help guide the discussion. Public HealthPreparing for Future Pandemics and Public Health Emergencies: An American College of Physicians Policy Position PaperPreparing the United States for the Next PandemicThe onset of the COVID-19 pandemic revealed significant gaps in the pandemic and public health emergency response system in the United States. In its position paper, ACP offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. The accompanying editorial reflects on lessons learned from the COVID-19 pandemic and the ACP recommendations and provides additional suggestions to ensure that the United States will be ready when the next health crisis hits.Use this article and the editorial to:Ask your learners to identify what they believe were the strengths and weaknesses of the U.S. public health system's management of the COVID-19 pandemic.Poll your learners: Will the United States be prepared should another pandemic emerge within the next 3 years?Review the ACP recommendations. Are there recommendations your learners would add or remove?Catholic Hospitals Should Improve Public Notification of Treatments They Conscientiously Refuse to ProvideIn the United States, Catholic institutions often invoke their legal right to refuse to provide treatments that do not align with Catholic values. The authors of this article contend that these institutions have a responsibility to provide advance notification of these restrictions and offer steps for improving notification.Use this article to: Watch the Author Insight Video with your learners. Go to your institution's website to see how it provides information on the reproductive health services it provides.Discuss with your learners whether they agree with the authors that Catholic hospitals should improve public notification of the services they refuse to provide.Travel MedicinePrimary care physicians are frequent sources of health advice for U.S. international travelers. International travel can result in new illness or exacerbate existing conditions. Primary care providers should be familiar with destination-specific disease risks, be knowledgeable about travel and routine vaccines, be prepared to prescribe chemoprophylaxis and self-treatment regimens, and be aware of travel medicine resources. They should also recognize travelers who would benefit from referral to a specialized travel clinic for evaluation. Those requiring yellow fever vaccination, immunocompromised hosts, pregnant persons, persons with multiple comorbid conditions, and travelers with complex itineraries may warrant specialty referral.Use this article to:Review where travel medicine services are available to patients who seek care at your institution. Go to the CDC website with your learners to review travel recommendations for hypothetical patients traveling to several different countries. Could the services they need be provided within the primary care setting at your institution, or would they need to be referred elsewhere? Review the indications for malaria prophylaxis.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics September 2023Volume 176, Issue 9 ePublished: 19 September 2023 Issue Published: September 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...